Healthcare Provider Details

I. General information

NPI: 1972059103
Provider Name (Legal Business Name): SAMIR ALRAJAB DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CANYON RIDGE DR
AUSTIN TX
78753-1632
US

IV. Provider business mailing address

11721 DOMAIN BLVD UNIT #3344
AUSTIN TX
78758
US

V. Phone/Fax

Practice location:
  • Phone: 512-837-2900
  • Fax:
Mailing address:
  • Phone: 832-860-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32219
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: